Cone‐beam computed tomography versus computed tomography‐guided ultrathin bronchoscopic diagnosis for peripheral pulmonary lesions: A propensity score‐matched analysis

Kawakita, Naoya; Takizawa, Hiromitsu; Toba, Hiroaki; Sakamoto, Shinichi; Miyamoto, Naoki; Matsumoto, Daisuke; Takashima, Mika; Tsuboi, Mitsuhiro; Yoshida, Misao; Kawakami, Yukikiyo; Kondo, Kazuya; Tangoku, Akira

doi:10.1111/resp.14016

Cited by 11 publications

(19 citation statements)

References 34 publications

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“…Other CBCT-NB literature report a wide range of diagnostic accuracies. Reported diagnostic accuracies in the range of 70%, such as Kawakita et al (72.9%),31 Casal et al (70%)32 and our own cohort when including the learning curve (76.4%13) would not be cost-effective when compared with TTNB in our model. Other centres have, however, reported higher outcomes, with Ali et al 33 reporting a diagnostic accuracy of 90% and Pritchett et al 83.7% 11.…”

Section: Discussionmentioning

confidence: 73%

Cone beam CT-guided navigation bronchoscopy: a cost-effective alternative to CT-guided transthoracic biopsy for diagnosis of peripheral pulmonary nodules

et al. 2022

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ObjectivesTo determine if cone beam CT-guided navigation bronchoscopy (CBCT-NB) is a cost-effective diagnostic procedure in patients with a pulmonary nodule (PN) with an intermediate risk for lung cancer.Materials and methodsTwo decision analytical models were developed to compare the long-term costs, survival and quality of life. In the first model, CBCT-NB was compared with CT-guided transthoracic needle biopsy (TTNB) in TTNB eligible patients. In the second model, CBCT-NB was compared with direct treatment (without pathology proven lung cancer) in patients for whom TTNB is not suitable. Input data were gathered in-house, from literature and expert opinion. Effects were expressed in quality-adjusted life years (QALYs). Sensitivity analyses were used to assess uncertainty.ResultsCBCT-NB can be cost-effective in TTNB eligible patients with an incremental cost-effectiveness ratio of €18 416 in an expert setting. The probabilistic sensitivity analysis showed that in 69% and 90% of iterations CBCT-NB remained cost-effective assuming a willingness to pay (WTP) of €20 000 and €80 000 per QALY. CBCT-NB dominated in the treatment strategy in which TTNB is not suitable. The probabilistic sensitivity analysis showed that in 95% of iterations CBCT-NB remained the dominant strategy, and CBCT-NB remained cost-effective in 100% of iterations assuming a WTP limit of €20 000. In the comparison between CBCT NB and TTNB, the deterministic sensitivity analysis showed that the diagnostic properties and costs of both procedures have a large impact on the outcome.ConclusionsCBCT-NB seems a cost-effective procedure when compared with TTNB and when compared with a direct treatment strategy in patients with an intermediate risk PN.

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Section: Discussionmentioning

confidence: 73%

Cone beam CT-guided navigation bronchoscopy: a cost-effective alternative to CT-guided transthoracic biopsy for diagnosis of peripheral pulmonary nodules

et al. 2022

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“…The recent development of 1.7 mm channel size allows the passage of r-EBUS [28], which provides a 360° view of the surrounding lesion by the ultrasound transducer [43] and shows a pooled diagnostic yield of 0.73 (95% CI, 0.70-0.76) [40]. The r-EBUS probe position relative to the lesion was known to be associated with the diagnostic yield of TBB, where the diagnostic yield of within, adjacent to, and outside the lesion was Shinagawa 2004 [24] Yamamoto 2004 [25] Shinagawa 2007 [26] Tachihara 2007 [27] Oki 2009 [28] Matsuno 2011 [22] Oki 2012 [29] Asano 2013 [30] Oki 2015 [31] Franzen 2016 [32] Tokoro 2016 [33] Ali 2019 [34] Diez-Ferrer 2019 [35] Oki 2019 [13] Sehgal 2019 [36] Sumi 2020 [37] Kawakita 2021 [38] Sumi 2021 [39] Zheng 2021 [23] Total (95% CI) 0.83, 0.61, and 0.04, respectively (p < 0.001) [44]. In line with this, Nishi et al [45] reported that UTB showed improved r-EBUS probe position for PPL after substituting thin bronchoscope (adjacent, 12; not visible, 32) by UTB (within, 26; adjacent, 11; not visible, 7) combined with fluoroscopy and VBN.…”

Section: Discussionmentioning

confidence: 99%

Ultrathin Bronchoscopy for the Diagnosis of Peripheral Pulmonary Lesions: A Meta-Analysis

Kim

Pak

et al. 2022

Respiration

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Background: Ultrathin bronchoscopy (external diameter, ≤3.5 mm) is useful for the diagnosis of peripheral pulmonary lesions because of its good accessibility. Objectives: We performed a meta-analysis to investigate the diagnostic yield of ultrathin bronchoscopy for peripheral pulmonary lesions. Methods: We performed a systematic search of MEDLINE and EMBASE (from inception to May 2021), and meta-analysis was performed using R software. The diagnostic yield was evaluated by dividing the number of successful diagnoses by the total number of lesions, and subgroup analysis was performed to identify related factors. Results: Nineteen studies with a total of 1,977 peripheral pulmonary lesions were included. The pooled diagnostic yield of ultrathin bronchoscopy was 0.65 (95% confidence interval, 0.60–0.70). Significant heterogeneity was observed among studies (χ2, 87.75; p < 0.01; I2, 79.5%). In a subgroup analysis, ultrathin bronchoscopy with 1.2 mm channel size showed a diagnostic yield of 0.61 (95% confidence interval, 0.53–0.68), whereas ultrathin bronchoscopy with 1.7 mm channel size showed 0.70 (95% confidence interval, 0.66–0.74) (χ2, 5.35; p = 0.02). In addition, there was a significant difference in diagnostic yield based on lesion size, histologic diagnosis (malignant vs. benign), bronchus sign, and lesion location from the hilum, whereas no significant difference was found based on lobar location. The overall complication rate of ultrathin bronchoscopy was 2.7% (pneumothorax, 1.1%). Conclusions: Ultrathin bronchoscopy is an excellent tool for peripheral pulmonary lesion diagnosis with a low complication rate. The diagnostic yield of ultrathin bronchoscopy was significantly higher with larger channel size, which might be attributed to the availability of radial endobronchial ultrasound.

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“…CBCT employs a flexible C‐arm that scans images in a cone shape rather than the traditional fan shape, providing 3D images with 200–300 times less radiation than conventional CT. In a study comparing ultrathin bronchoscopy with VBN using CBCT versus CT guidance, the diagnostic yield was 72.9% versus 47.9%, respectively 63 . In a prospective cross‐over study comparing primary guidance modalities of CBCT and EMN, navigation success was 89.9% when the two modalities were combined.…”

Section: Interventional Pulmonologymentioning

confidence: 99%

“…In a study comparing ultrathin bronchoscopy with VBN using CBCT versus CT guidance, the diagnostic yield was 72.9% versus 47.9%, respectively. 63 In a prospective cross-over study comparing primary guidance modalities of CBCT and EMN, navigation success was 89.9% when the two modalities were combined. However, overall diagnostic accuracy remained lower than navigation success at 72.4%.…”

Section: Fluoroscopic Navigation and Cbctmentioning

confidence: 99%

Contemporary Concise Review 2021: Pulmonary nodules from detection to intervention

Leong

2022

Respirology

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The US Preventive Task Force (USPSTF) has updated screening criteria by expanding age range and reducing smoking history required for eligibility; the International Lung Screen Trial (ILST) data have shown that PLCOM2012 performs better for eligibility than USPSTF criteria.• Screening adherence is low (4%-6% of potential eligible candidates in the United States) and depends upon multiple system and patient/candidate-related factors.• Smoking cessation in lung cancer improves survival (past prospective trial data, updated meta-analysis data); smoking cessation is an essential component of lung cancer screening. • Circulating biomarkers are emerging to optimize screening and early diagnosis.• COVID-19 continues to affect lung cancer treatment and screening through delays and disruptions; specific operational challenges need to be met. • Over 70% of suspected malignant lesions develop in the periphery of the lungs.Bronchoscopic navigational techniques have been steadily improving to allow greater accuracy with target lesion approximation and therefore diagnostic yield. • Fibre-based imaging techniques provide real-time microscopic tumour visualization, with potential diagnostic benefits. • With significant advances in peripheral lung cancer localization, bronchoscopically delivered ablative therapies are an emerging field in limited stage primary and oligometastatic disease. • In advanced stage lung cancer, small-volume samples acquired through bronchoscopic techniques yield material of sufficient quantity and quality to support clinically relevant biomarker assessment.

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Cone‐beam computed tomography versus computed tomography‐guided ultrathin bronchoscopic diagnosis for peripheral pulmonary lesions: A propensity score‐matched analysis

Cited by 11 publications

References 34 publications

Cone beam CT-guided navigation bronchoscopy: a cost-effective alternative to CT-guided transthoracic biopsy for diagnosis of peripheral pulmonary nodules

Cone beam CT-guided navigation bronchoscopy: a cost-effective alternative to CT-guided transthoracic biopsy for diagnosis of peripheral pulmonary nodules

Ultrathin Bronchoscopy for the Diagnosis of Peripheral Pulmonary Lesions: A Meta-Analysis

Contemporary Concise Review 2021: Pulmonary nodules from detection to intervention

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